Nosocomial infections and possibilities of their management in district and county hospitals

Aim: to assess the incidence of nosocomial infections and possibilities of their management in district and county hospitals. Objectives: 1) to assess the incidence and structure of nosocomial infections in district and county hospitals in Lithuania, 2) to determine and compare the risk factors of nosocomial infections in district and county hospitals, 3) to develop proposals for the improvement of nosocomial infection management. Methodology. The analysis was carried out in 4 district and 2 county hospitals, at the departments of general surgery, orthopedics and traumatology, reanimation and intensive therapy, obstetrics and gynaecology.. Nosocomial infection registration records presented in case histories served as a primary source of information. 2002 cases of nosocomial infections that occurred in 2005 were investigated. The data of the cases of nosocomial infections were compared with the records in nosocomial infection registers and reports in Public Health Centres. Statistical analysis of the research data was performed applying statistical functions of the Microsoft EXCEL spreadsheet and the functions of the task analysis subsystem Data Analysis. Results: The incidence of nosocomial infections was 3.1%, 3.2%, 2.8%, and 3.3% in the district hospitals, and 4.0%, 4.6% in the county hospitals. The major risk factors were surgery (24%), intravenous implement (22.9%), pneumonia (16.8%), and other respiratory infections (13.9%). The cases of nosocomial infections occurring in the district hospitals were not recorded in registers or in Public Health Centres. The county hospitals had 66.0% of cases recorded. The distribution of nosocomial infections were the most common in the departments of surgery (22.0%), intensive care (13.9%) and orthopedics-traumatology (7.7%). A mathematical model for the prognosis of nosocomial infections has been designed enabling to forecast a possible number (and the incidence rate) of nosocomial infections by the number of patients in hospitals. The length of hospitalization longer than 7 days increased the risk of nosocomial infection by 6.6%. Conclusions: The incidence rate of nosocomial infections in the hospitals was 4.1%. In the county hospitals it was higher than in the district hospitals. The most common risk factors were surgery, intravenous implement, pneumonia, and other respiratory diseases. Nosocomial infections in the district hospitals are not recorded and in the county hospitals are only partly recorded. The form and the way of registration of nosocomial infections should be simplified